Prescribing Safety Assessment (PSA) Practice Exam

Which medication is best for diabetic neuropathy-related pain?

1. Amitriptyline 10mg PO ON

2. Duloxetine 60mg PO OD

3. Gabapentin 300mg

4. Naproxen 500mg

The correct answer is: Duloxetine 60mg PO OD

Duloxetine, at a dosage of 60 mg once daily, is considered the most effective option for managing diabetic neuropathy-related pain. This medication is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has been specifically approved for the treatment of neuropathic pain, including diabetic peripheral neuropathy. Clinical studies have demonstrated its efficacy in relieving pain symptoms associated with this condition while also potentially improving mood, which can be beneficial for patients experiencing depression alongside their neuropathic pain. The other medications, while they may have their own roles, are not as directly aligned with treating diabetic neuropathy-related pain. Amitriptyline is sometimes used for neuropathic pain, especially at lower doses, but the typical starting dose usually starts higher or requires titration; thus, 10 mg may not be the most effective dose for all patients. Gabapentin can also be effective in neuropathic pain management, but it often requires dose escalation and may not show benefits until reaching higher doses. Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), is primarily indicated for inflammatory pain and does not target the neuropathic component of diabetic pain. Therefore, Duloxetine is the most appropriate medication in this context for